The Opium Habit

by Horace B. Day

A further condition lies in the attempt being made under the most favorable circumstances in respect to absolute leisure from business of every kind. That nothing can be accomplished by persons whose time is not at their own command, by a graduated effort protracted through many months, I do not say, for I do not believe it; but any speedy relinquishment of opium—that is, within a month or two—seems to me to be wholly impossible, except to those who are so situated that they can give up their whole time and attention to the effort.

This effort should be made with the advice and under the eye of an intelligent physician. So far as I have had opportunity to know, the profession generally is not well informed on the subject. In my own case I certainly found no one who seemed familiar with the phenomena pertaining to the relinquishment of opium, or whose suggestions indicated even in cases where the physician has had no experience whatever in this class of disorders, he can, if a well-educated man, bring his medical knowledge and medical reasoning to bear upon the various states, both of body and mind, which the varying sufferings of the patient may make known to him. Were there, indeed, no professional helps to be secured by such consultation, it is still of infinite service to the patient to know some one to whom he can frequently impart the history of his struggle and the progress he is making. Such confidence may do much to encourage the patient, and no one is so proper a person in whom to repose this confidence as an intelligent physician.

The amount of time which should be devoted to the experiment must depend very greatly upon these considerations—the constitution of the patient, the length of time which has elapsed since the habit was formed, and the quantity habitually taken. When the habit is of recent date, and the daily dose has not been large—say not more than ten or twelve grains—if the patient has average health, his emancipation from the evil may be attained in a comparatively short period, though not without many sharp pangs and many wakeful nights which will call for the exercise of all his resolution.

The question will naturally suggest itself to others, as it has often done to myself, whether a less sudden relinquishment of opium would not be preferable as being attended with less present and less subsequent suffering. Numerous cases have come under my notice where a very gradual reduction was attempted, but which resulted in failure. Only two exceptions are known to me: in one of these the patient, himself a physician, effected his release by a graduated reduction extending through five months. The other is the case of Dr. S., a physician of eminence in Connecticut many years ago. This gentleman had made so free use of opium to counteract a tendency to consumption that the habit became established. After several years, and at the suggestion of his wife, he made a resolution to abandon it, engaging to take no opium except as it passed through her hands, but with the understanding that the process of relinquishment was to be slow and gradual. His allowance at this time was understood to be from twenty to thirty grains of crude opium daily. At the end of two years the habit was abandoned, with no very serious suffering during the time, and so far as his daughter was informed, with no subsequent inconvenience to himself. He lived many years after his disuse of opium, in the active discharge of the duties of his profession, and died at last in the ninetieth year of his age. The hazard of this course, however, consists in the possibility, not to say with some temperaments the probability, that somewhere in the course of so very gradual a descent the same influences which led originally to the use of opium may recur, with no counteracting influence derived from the excitement of the mind produced by the earnestness of the struggle. With some constitutions I have no doubt that a process even so slow as that of Dr. S.'s might be successful, but I suspect, with most men, that some mood of excited feeling, and some conscious sense of conflict, will be found necessary, in order to bring them up resolutely to the work of self-emancipation. On the other hand, I am satisfied that my own descent was too rapid. Had the experiment of between five and six weeks been protracted to twice that time, much of the immediate suffering, and probably more of that which soon followed, might have been prevented. As in the constitution of every person there is a limit beyond which further indulgence in any pernicious habit results in chronic derangement, so also there seems to be a limit in the discontinuance of accustomed indulgence, going beyond which is sure to result in some increased physical disorder. In the cure of delirium tremens, the first step of the physician is to stimulate. With more moderate drinkers abrupt cessation from the use of stimulants is the only sure remedy. In the first instance the nervous system is too violently agitated to dispense entirely with the accustomed habit; in the second, the nerves are presumed to be able to bear the temporary strain imposed upon them by the condition of the stomach and other organs. But with opium the case is otherwise. Insanity, I think, would be the general result of an attempt immediately to relinquish the habit by those who have long indulged it. The most the opium-eater can do is to diminish his allowance as rapidly as is safe. For the same reason that no sensible physician would direct the confinement of a patient and the absolute disuse of opium with the certainty that mania would result, so it would be equally ill advised to recommend a diminution so rapid as necessarily to call out the most serious disorder and derangement of all the bodily functions, especially if these could be made more endurable by being spread over a longer period. In one respect the opium-eater has greatly the advantage over those addicted to other bad habits. Those who have used distilled or fermented drinks, tobacco, and sometimes coffee and tea in excess, experience for a time a strong and definite craving for the wonted indulgence. This is never the case with the opium-eater; he has no specific desire whatever for the drug. The only difficulty he has to encounter is the agony of pain—for no other word adequately expresses the suffering he endures—conjoined with a general desire for relief. Yet in the very acme of his punishment he will be sensible of no craving for opium at all like the craving of the drunkard for spirits. As De Quincey justly represents it, the feeling is more that of a person under actual torture, aching for relief, though with no care from what source that relief comes. So far from there being any particular desire for opium, there ensues very speedily, I suspect, after the attempt to abandon it is begun, and long before the necessity for its use has ceased, and even while the suffering from its partial disuse is most unendurable, a feeling in reference to the drug itself not far removed from disgust. The only occasion that I have had of late years to make use of opium or any of its preparations, was within a twelvemonth after it had been laid aside. A morbid feeling had long troubled me with the suggestion that should a necessity ever arise for the medical use of opium, I might be precipitated back into the habit. I was not sorry, therefore, when the necessity for its use occurred, that I might test the correctness of my apprehension. To my surprise, not only was no desire for a second trial of its virtues awakened, but the very effort to swallow the pill was accompanied with a feeling akin to loathing.

The final decision of the question, How long a time should be allowed for the final relinquishment of the drug? must, I imagine, be left to a wider experience than has yet been recorded. The general strength of the constitution, the force of the will, the degree of nervous sensibility, together with the external circumstances of one's life, have all much to do with its proper explication.

The general directions I should be disposed to suggest for the observance of the confirmed opium-eater would be something as follows:

1. To diminish the daily allowance as rapidly as possible to one-half. A fortnight's time should effect this without serious suffering, or any thing more than the slight irritation and some other inconveniences that will be found quite endurable to one who is in earnest in his purpose.

2. For the first week, if the previous habit has been to take the daily dose in a single portion, or even in two portions, morning and night, it will be found advisable to divide the diminished quantity into four parts. Thus, if eighty grains has been the customary quantity taken, four pills of fifteen grains each, taken at regular intervals, say one at eight and one at twelve o'clock in the morning, and one at four and one at eight in the evening, will be found nearly equal in their effect to the eighty grains taken at once in the morning. A further diminution of two grains a day, or of half a grain in each of these four daily portions, will within the week reduce the quantity taken to fifty grains, and this without much difficulty, and with positive gain in respect to elasticity of spirits, arising, in part, from the newly-awakened hope of ultimate success. A second week should suffice for a reduction to forty grains. It will probably be better to divide the slightly diminished daily allowance into five portions, to be taken at intervals of two hours from rising in the morning till the daily quantity is consumed. With such a graduated scale of descent, it will be found at the end of two weeks that one-half of the original quantity of opium has been abandoned, and that, with so little pain of body, and so much gain to the general health and spirits, that the completion of the task will seem to the patient ridiculously easy. He will soon learn, however, that he has not found out all the truth.

In the third week a further gain of ten grains can the more easily be made by still further dividing the daily portion into an increased number of parts, say ten. The feeling of restlessness and irritability by this time will have become somewhat annoying, and the actual struggle will be seen to have commenced. It will doubtless require at this point some persistence of character to bear up against the increased impatience, both of body and spirit, which marks this stage of the descent. The feelings will endeavor to palm off upon the judgment a variety of reasons why, for a time, a larger quantity should be taken; but this is merely the effect of the diminished amount of the stimulant. Sleep will probably be found to be of short continuance as well as a good deal broken. Reading has ceased to interest, and a fidgety, fault-finding temper not unlikely has begun to exhibit itself. At this point, I am satisfied, most opium-eaters who have endeavored in vain to renounce the habit, have broken down. Their resolution has failed them not because they were unable to stand much greater punishment than had yet been inflicted, but because they yielded to the impression that some other time would prove more opportune for the final experiment. Under this delusion they have foolishly thrown away the benefit of their past self-control, with the certainty that should the trial be again made, they would once more be assailed by a similar temptation. But if this stage of the process has been safely passed, the next—that of reducing the daily quantity from thirty grains to twenty-five, still dividing the day's allowance into ten portions—would probably have added little aggravation to the uncomfortable feeling which already existed, but not without some conscious addition, on the other hand, to their enjoyment from the partially successful result of the experiment. Thus in four weeks a very substantial gain, by the reduction of the needed quantity from eighty grains to twenty-five, would have been attained.

If the patient should find it necessary to stop at this point for a week, a fortnight, or even longer, no great harm would necessarily result; it would only postpone by so much his ultimate triumph. He should never forget, however, that the one indispensable condition of success is this: Never under any circumstances to give up what has been once gained. If in any manner the patient has been able to get through the day with the use of only twenty-five grains, it is certain that he can get through the next, and the next, and the subsequent day with the same amount, with the further certainty that the habit of being content with this minimum quantity will soon begin to be established, and that speedily a further advance may be made in the direction of an entire disuse. Whenever the patient finds his condition to be somewhat more endurable, whether the time be longer or shorter, he should make a still further reduction, say to one-quarter of his original dose. If this abatement of quantity be spread over the entire week the aggravation of his discomfort will not be great, while the elation of his spirits over what he has already accomplished will go far in enabling him to bear the degree of pain which necessarily pertains to the stage of the experiment which he has now reached. The caution, however, must be borne continually in mind that under no circumstances and on no pretext must the patient entertain the idea that any part of that which he has gained can he surrendered. Better for him to be years in the accomplishment of his deliverance than to recede a step from any advantage he may have secured. If he persists, he will in a few days, or at the longest in a few weeks, find his condition as to bodily pain endurable if nothing more. There may not, probably will not be any very appreciable gain from day to day. The excited sufferer, judging from his feelings alone, may think that he has made no progress whatever; but if after the lapse of a week he will contrast his command of temper, or his ability to fix his attention upon a subject, as evinced at the beginning and end of this period, he can hardly fail to see that there has been a real if not a very marked advance in his status. Such a person has no right to expect, after years of uninterrupted indulgence, that the most obstinate of all habits can be relinquished with ease, or that he can escape the penalty which is wisely and kindly attached to all departures from the natural or supernatural laws which govern the world. It should be enough for him to know that there is no habit of mind or of body which may not be overcome, and that the process of overcoming, in its infinite variety of forms, is that out of which almost all that is good in character or conduct grows, and that the amount of this good is usually measured by the struggle which has been found necessary to ensure success.